RAISING CONFIDENT CHILDREN

In an earlier blog, "Risk of Suicide and of Suicide Attempts," I described a study by Hart and Risley that followed 42 families for 3 1/2 years counting the number and nature of words directed to young children aged 7months to 2 1/2 years with the families divided into three groups identified as professional, working class and welfare.  Hart and Risley found that the more words spoken to these very young children the better their vocabulary, the higher their IQ and better their success in school.  Their success continued into adulthood.

The difference in words spoken was dramatic as over the first 4 years of a child's life.  In the professional category of family, the child would hear 48 million words, while those from working classs families would hear 23 million words and those from the welfare category of family would hear 13 million words.  The difference in number of words the children heard was correlated for chldren from welfare families starting school 12-14 months behind the children from professional families. Follow-up studies found that this difference was not made up even with efforts by the schools to increase their vocabularies.  The study also found that children are more confident [and successful] if they hear more positive words directed to them when they are young [and older too].  

So, it may be obvious why I consider this important.  All of us can talk more to our children [not just asking questions!].  We can also encourage and support our children as this will improve their self-conficence and reduce risk that they will be suicidal or attempt suicide.  This indicates how important it is to be positive with our children.  It is also a good way to be with each other as parents and really with anyone.  

If more of us were encouraging and supportive with people that we interact with, the stress level around us would be a lot less.  Let's give it a try.

MOOD SWITCHING WITH ANTIDEPRESSANT USE

Diagnosing bipolar depression vs unipolar depression [major depression] remains difficult.  So why be concerned?  Well, there is building evidence that taking antidepressants and having a mood swing to a manic or hypomanic mood is associated with a poorer prognosis that includes more depressive mood swings [rapid cycling?], not responding as well to mood stabilizing medications, increased risk for substance abuse, more disability, and more mortality from suicide or from medical illnesses.  Also, there is a statistically higher risk of switching moods with antidepressant use in adolescents compared to adults. One explanation is that the adults are more likely to have their bipolar illness diagnosed.  There is also evidence that there are more mood swings to mania or hypomania associated with antidepressant use than those that switch spontaneously.  This could reflect how difficult it is to distinguish bipolar depression from unipolar or major depression.  In the past this switching was considered a side-effect of antidepressants and not indicative of bipolar illness.  This apparent resistance to diagnosing bipolar illness may represent the prevalence of irritability with major depression, the worse prognosis of bipolar illness, and the difficulty lifting a stable bipolar depressed mood with mood stabilizing medications.  

So, what to do?  There are a number of factors that are associated with an increased risk for switching moods on antidepressants.  These include: a family history of bipolar illness or psychosis; onset of symptoms before age 25; number of depressive episodes within several years; cyclothymic, and irritability symptoms; past post partum mood disorder symptoms; depression with psychomotor retardation, hyersomnia and increased appetite [pointing toward Bipolar Type II diagnosis]; history of excitation on mood elevating medications [basically antidepressants]; current agitated and dysphoric symptoms; possible comorbid substance abuse; and treatment with a tricyclic antidepressant or venlafaxine or duloxetine [any antidepressant known to significantly elevate more than one neurotransmitter].

After taking into consideration the above, I have found that if someone's moods are cycling it is often possible to stabilize moods, with mood stabilizing medications, without having to use antidepressants. However, if someone has symptoms suggesting bipolar depression and yet is stable [stuck] in a depressed mood, I will treat briefly with an antidepressant [often escitalopram due to quicker response] and then begin tapering it and discontinuing it after a couple of weeks of improved mood.  If the taper or discontinuation leads to return of depressive symptoms then I reinstate the antidepressant at the previous dose and then the taper and/or discontinuation is tried a couple of weeks later.  At some point I have found it is possible to stop the antidepressant and the improved mood is maintained.  Meanwhile, I have initiated a mood stabilizing medication that then will hopefully hold the improved mood.    

JUST BREATHE REVISITED

Previously I blogged about the stress relieving benefit of slow, even breathing.  Since then it continues to come up directly or indirectly with different approaches to stress management.  It is frequently referred to as "mindfulness."  This has been defined as consciousness without thought.  I wonder if it may be better defined as a calm, alert state with active efforts to clear one's mind from worries, future events, past events, etc., so that we are open to what life might bring us.  Being aware of our breathing as we focus on it becoming slow and even, is one way to achieve this state of "mindfulness" that is available to anyone who commits to practicing this type of breathing on a daily basis.  Intrerestingly, it seems to be an important part of the brain training treatments for ADHD and PTSD as well as a way to improve working memory and reading levels in people.  The latter reference is to studies involving mindfulness training undertaken by Michael Mrazek and his colleagues at UC-Santa Barbara who are introducing mindfulness practices into elementary schools. 

The benefits of meditation, mindfulness and breathing practices have been well established.  It seems like a number of treatments represent attempts to achieve a meditative/mindful state more quickly by reinforcing certain brain wave patterns that are associated with being calm and alert and focused. These same brain wave patterns can be achieved through breathing exercises and other meditative practices. I am eager to learn the results of Dr. Mrazek and colleagues attempts to implement mindfulness practices in elementary level school systems.  This could have a significant positive impact on the lives of these children and possibly spread to their family members.  

As I ended the other blog about breathing, I will end this one the same way.  JUST BREATHE.

LOSS...WHY THOSE INTENSE EMOTIONS ARE IMPORTANT

My family and I just experienced the loss of our dog, Lexi.  About 11 years ago we agreed to bring her into our lives as she was a puppy who was chewing up our oldest daughter's furniture after she had rescued Lexi from the shelter.  Lexi became a very important part of our family, especially for my wife and for me. Lexi shared our lives in so many ways and this was never so apparent than when she was no longer with us.  Lexi developed difficulty swallowing and died a week later with an untreatable cancer.

My wife and I shared many tears for the first several days and then we had moments every day where the tears returned.  We also shared memories of Lexi with each other and with friends.  We were open with our friends about our sadness and grief.  After several days, we tried to limit the amount of time we let ourselves experience intense feelings of grief, to 15-20 minutes a day [and we decide when that time is each day].  I have found that this technique is helpful in limiting the amount of time we feel at the mercy of our emotions as we give ourselves control by deciding when and how long we will be actively experiencing these emotions. 

Letting ourselves experience intense emotions and having control over when we experience them helps us to learn that intense feelings are ok and actually enrich our lives.  It is important for us to educate our brains that intensity is safe when it comes to emotions and other experiences in our lives.  Since most of us have experienced events that were traumatic and overwelming, it is helpful to realize that there are safe types of intensity that are not overwelming and that are important for us to experience and value in our lives. 

EQUAL INSURANCE COVERAGE FOR MENTAL ILLNESSES [PARITY]

In 2008 a law was passed that required parity in coverage so that coverage for mental health and substance abuse services had to be the same coverage as that for medical and surgical services. However, this law did not require.mental health and substance abuse services and there were other loop holes so that insurers could get around the parity mandate. 

Now the Affordable Care Act mandates that mental health and substance abuse services be provided by all insurers and that parity exist with medical and surgical services.  It is easy to underestimate the significance of the availability of mental health and substance abuse services to millions of people who previously did not have them.  Even though there have been predictions of increased costs to insurers, it is likely that the costs will go down since it is estimated that 67% of primary care visits are due to psychiatric or substance abuse problems.  Having these problems effectively treated will likely lower the costs for insurers for all the problems that are caused by stress and only effectively treated by addressing the stress directly by mental health and substance abuse services.  This does depend on the services being available and the insurers providing the coverage for them.  This will also depend on state insurance commissioners enforcing the law for those insurers who refuse to follow the law.

I hope that the availability of mental health and substance abuse services and parity will help remove more of the stigma that is all too often attached to those of us who require these services.  It is time that this kind of ignorance is no longer tolerated.